The virtual dream: rewriting stories of loss and grief

The meaning in loss protocol: A clinical trial of online grief therapy

For a minority of the bereaved, the loss of a significant other can trigger an overwhelming emotional reaction and impaired functioning across life domains, known as prolonged grief disorder (PGD). Hence, ongoing efforts have been made to refine existing treatments to increase their efficacy and to accommodate the idiosyncrasies of grief reactions. This study presents the results of an open clinical trial of the feasibility and effectiveness of the Meaning in Loss (MIL) protocol in an online format. The brief intervention of 12 to 16 sessions combines constructivist and narrative strategies to explore and work through impediments to meaning reconstruction in loss. The sample included 25 participants diagnosed with PGD who were treated by six therapists. Baseline and post-therapy comparisons showed a significant improvement in all clinical measures (grief symptomatology, depression and general distress) and an increase of meaning making regarding the loss. Meaning making was found to be a prospective mediator of symptomatic improvement in grief across the course of therapy. These findings suggest the effectiveness of the MIL protocol in decreasing grief specific and associated symptomatology and argue for the relevance of further controlled evaluations of its efficacy. Moreover, results confirm previous findings that meaning making is a relevant factor in the evolution of grief reactions, including in the context of psychotherapy.

Meaning Making in Wartime Bereavement: Lessons Learned From Bereaved Parents and Siblings

Wartime deaths are traumatic and leave many grieving families in their wake. Yet, the unique, nuanced bereavement needs and experiences of those who remain are largely unknown. This Canadian, qualitative study examined the bereavement experiences of family of origin, bereaved during the mission to Afghanistan. The findings provide rich data on the predominant ways in which family members found and made meaning following the death and the ways in which military culture influenced the meanings made.

Revie ⊕: the influence of a life review intervention including a positive, patient-centered approach towards enhancing the personal dignity of patients with advanced cancer-a study protocol for a feasibility study using a mixed method investigation

BACKGROUND

It is generally recognized that existential concerns must be addressed to promote the dignity of patients with advanced cancer. A number of interventions have been developed in this regard, such as dignity therapy and other life review interventions (LRI). However, so far, none have focused on a positive approach or evaluated its effects on dignity and personal growth. This study aims to explore the feasibility of Revie ⊕, a life review intervention comprising a positive, patient-centered approach, and to determine potential changes of patients' sense of dignity, posttraumatic growth, and satisfaction with life.

METHODS

A mixed method study will be performed, which includes specialized nurses and 40 patients with advanced cancer in an ambulatory and in-patient setting of a Swiss university hospital. Quantitative methods involve a single group, pre- and post-intervention, and outcome measurements include the Patient Dignity Inventory, the Posttraumatic Growth Inventory, and the Satisfaction with Life Scale. Feasibility data relating to process, resource, and scientific elements of the trial will also be collected. A semi-directed interview will be used to collect qualitative data about the process and the participants' experiences of the intervention. In this way, enhanced quantitative-qualitative evidence can be drawn from outcome measures as well as individual, contextualized personal views, to help inform researchers about the plausibility of this complex intervention before testing its effectiveness in a subsequent full trial.

DISCUSSION

Patient dignity is a goal of quality end-of-life care. To our knowledge, this is the first trial to evaluate the role of a life review intervention that is focused on personal growth and on changes relating to the experience of having cancer. This study will evaluate the feasibility of a novel intervention, Revie ⊕, which we hope will contribute to promote the dignity, personal growth, and overall life satisfaction of patients with advanced cancer.

TRIAL REGISTRATION

ISRCTN, ISRCTN12497093.

Meaning Reconstruction in the Wake of Loss: Evolution of a Research Program

As theories of bereavement have evolved, so too have evidence-based interventions to mitigate complications in post-loss adaptation. This article reviews one line of programmatic research grounded in a conceptualisation of grieving as an attempt to reaffirm or reconstruct a world of meaning challenged by loss. Anchored in therapeutic encounters with the bereaved, a meaning reconstruction approach to loss has grown over the past 15 years to generate an increasingly substantial research base, as well as to develop and refine a wide array of contributions to psychological assessment and therapy. By summarising the major models, measures and methods resulting from this collaborative work, it offers an introduction to meaning reconstruction for those unfamiliar with it, noting its contributions to date, its areas of future development, and its relevance for clinical practice.

Assessing a Buddhist treatment for bereavement and loss: the mustard seed project

From a Buddhist perspective, grief becomes complicated because mourners have trouble accommodating the reality of impermanence in the face of deep and unwelcome change, as they struggle to make sense of the "event story" of their loss and to revise their life story and identity accordingly. Joining this perspective with a constructivist emphasis on grieving as meaning reconstruction, we developed a distinctive group intervention to help people reflect on the natural conditions of impermanence and limitation in a compassionate environment in which they were encouraged to cultivate a new self-narrative in the wake of loss. Integrating meditative interludes, dyadic sharing, dharma lessons, and informal didactics on the human quest for meaning, we used expressive arts exercises to engage the existential dilemmas of loss from a self-distancing perspective. Evidence from an open trial on 41 participants in 2 groups documents that the intervention is both feasible and acceptable to clients, and that they display significant decreases in grief related suffering, and corresponding increases in meaning making and personal growth, across the brief course of the workshop experience.